11/2/2013 Presenter Disclosures From 20 to 200-plus: Disseminating Best Practices Chinyere Alu across the Spectrum of Care in the Illinois Campaign to The following personal financial relationships with commercial interests relevant to this presentation Eliminate Clostridium difficile existed during the past 12 months: Chinyere Alu, MPH No relationships to disclose Division of Patient Safety and Quality Illinois Department of Public Health November 2013 Acknowledgments Objectives • Identify key strategies used in disseminating best Illinois Department of Public Health (IDPH) • Erica Abu-Ghallous, MSN, MPH, RN • Rose Karim, IDPH practices in the Illinois Campaign to Eliminate • Jessica Ledesma, MEd, MPH • Mary Driscoll, RN, MPH Clostridium difficile (ICE C. diff ) • Barbara Fischer, RN, IDPH • Discuss ways to build effective partnerships for Illinois Quality Improvement Organization, Telligen • Debbie Camacho, MA, BSN, RN disseminating best practices Illinois Clostridium difficile Stakeholder Group • Discuss the role of the state health department in facilitating Clostridium difficile infection (CDI) prevention Centers for Disease Control and Prevention across the healthcare continuum • Ronda Sinkowitz-Cochran, MPH 1
11/2/2013 Clostridium difficile Clostridium difficile Infections (CDI) Risk factors for CDI acquisition • Bacterium that causes inflammation • Antibiotic use of the colon • Recent medical care • Shed in the feces • Advanced age • Spores can live for months on • Underlying illness environmental surfaces • Tube feeds • Symptoms include watery diarrhea, excess medical costs fever, abdominal pain, nausea, loss of appetite deaths per year in US increase in incidence in Illinois hospitals over ten years Dubberke ER, Reske KA, Olsen MA, McDonald LC, Fraser VJ. Short- and long-term attributable costs of Clostridium difficile-associated disease in nonsurgical inpatients. Clin Infect Dis 2008;46:497 – 504. Clostridium difficile in Illinois Hospitals, 2010. Available at http://www.healthcarereportcard.illinois.gov/files/pdf/cdiff2010.pdf. Starting from 20 facilities: Moving to 200-plus facilities Illinois CDI Prevention Collaborative Target audience Underscored importance of • Acute care hospitals and long- term care facilities (LTCFs) • Support from leadership and key players Goals • Disseminate evidence-based • Multidisciplinary collaboration best practices for CDI • Evidence-based guidance and prevention practical tools • Facilitate and increase facility engagement in CDI prevention activities http://www.notjustamaidservice.com/ 2
11/2/2013 Getting Support from Leadership Strategies for Improving Dissemination of and Key Players Best Practices 1. Align the campaign with the strategic goals of the C. diff Stakeholder Get support from adopting organizations Group established leadership and 2. Increase recruitment by integrating opinion leaders Stakeholders invited key players into the enrollment process to endorse campaign as sponsors 3. Form a coalition of credible campaign sponsors Promote Facility leadership asked to 4. Generate a threshold of participating organizations multidisciplinary formally commit their facility to that maximizes network exchanges collaboration 1. Attend webinars 5. Create networks to foster learning opportunities 2. Send multidisciplinary team to workshop 6. Highlight evidence base and relative simplicity of 3. Set facility goal for CDI reduction Provide recommended practices evidence-based 7. Develop practical implementation tools and guides guidance and for key stakeholder groups practical tools 8. Incorporate monitoring and evaluation of Oct Jan April July Oct milestones and goals 2011 2012 2012 2012 2012 *Christina Yuan et al, May 2010. Eight Key Strategies for Improving the Dissemination of Best Practices by (National) CDC Vital Signs Report on CDI, March 2012 Quality Improvement Campaigns. Commonwealth Fund Issue Brief. Providing Evidence-based Guidelines and Incentives for Facility Participation Practical Tools “Menu of Strategies to Prevent Illinois policy context Clostridium difficile Infections” Webinars • Skilled nursing facilities required to have a designated Laboratory testing, Infection Prevention and Control Professional, effective environmental cleaning, January 2012 hand hygiene, contact precautions, implementing • Hospitals mandated to report C. diff rates, effective January rapid cycle improvements, 2012 promising methods for CDI • Public reporting of hospital C. diff rates on Illinois Hospital prevention and treatment Report Card, effective fall 2012 Recognition for championing patient safety • Facilities that signed up for the campaign listed on ICE C. diff website: http://www.idph.state.il.us/patientsafety/ice_home.htm Oct Jan April July Oct 2011 2012 2012 2012 2012 3
11/2/2013 “Menu of Strategies to Prevent Promoting Multidisciplinary Clostridium difficile Infections” Collaboration Regional Action planning tool addressing: workshops • Early and reliable detection of CDI: lab testing and diagnoses • Early and appropriate containment of CDI: safe and non- restrictive implementation of Contact Precautions • The “how” of • Cleaning and disinfection of the environment and implementing equipment CDI prevention activities • Inter-facility patient transfer • Action planning Oct Jan April July Oct 2011 2012 2012 2012 2012 Results Stakeholder Engagement • 23 organizations signed up as campaign sponsors • Stakeholder engagement • 120 hospitals and 134 LTCFs officially signed up for the • Facility implementation of CDI prevention activities campaign – More participated in activities without officially signing up • What facilities liked most about ICE C. diff • 199 to 410 phone lines used per webinar • >450 individuals total attended regional workshops 4
11/2/2013 Facility Implementation of CDI What Facilities Liked Most Prevention Activities About ICE C. diff • Heightened facility awareness of CDI and enhanced Hospital LTCF (N=82)* (N=51)* leadership support Facility’s leadership supported participation in the 83% 95% – “It brought the issue of increased nosocomial CDIs to the campaign forefront and helped us make changes within our facility.” Established a CDI prevention team as a result of the 61% 47% – “The ability to get involvement of leadership due to the campaign sponsorship of IDPH.” Implemented at least one intervention to prevent 77% 88% – “It made Administration hold nursing managers accountable CDI as a result of the campaign for assisting in the monitoring of Contact Precautions.” -Top areas of focus: Environmental cleaning, contact precautions, hand hygiene Agreed or strongly agreed that “ CDI prevention is 61% 81% now a greater priority in my facility as a result of the campaign” *Not all responded to each survey question What Facilities Liked Most Challenges About ICE C. diff • Facilitated information exchange among facilities • Reach to LTCFs – “[I]t was nice being part of the ICE team to hear what others were doing at their facilities.” • Diverse target audience with different learning needs – “The meeting was most beneficial as I heard that others were having similar issues and how they resolved them.” • Short time frame for planning and implementation • Provided evidence-based information through web- based and in-person learning – “I liked the ongoing educational opportunities followed up with team experience and sharing best practices.” – “I enjoyed the focused updated information from experts.” 5
11/2/2013 Looking Ahead Thank you C. diff is an “ urgent threat ” Centers for Disease Control and Prevention, Antibiotic Resistance Threats in the United States, 2013 Chinyere Alu@Illinois.gov 312-814-2565 New IDPH activities • CDI collaborative with acute care hospitals and LTCFs that share patients Illinois Campaign to Eliminate Clostridium difficile • Hospital antimicrobial stewardship collaborative http://www.idph.state.il.us/patientsafety/ice_home.htm • Assessment of antibiotic stewardship in LTCFs Key role for health departments • Facilitate collaboration among stakeholders • Influence buy-in from leadership and key players 6
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